Tax Documentation Reference Guide
|Tax Documentation |Original Effective Date: 12/21/09 |
|Standard Operating Procedure (SOP) | |
| |Revision Date: 01/08/18 |
|Main Menu |
|General Information |
|Other Acceptable Tax Documentation |Risk Mitigation Requirements |
|Other Company Types |Tax Documentation Background |
|Proof of Ownership |Type of Company and Length of Time in Business |
|Reconciling a Payroll Document |Unacceptable Tax Documentation |
|Reconciling a Wage and Tax Document |Wage and Tax Statement |
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|Common Law Employee Rule |
|General Rule: In order to qualify as a “group health plan” under ERISA, an employer must have at least 1 common law employee that is eligible and enrolled in |
|addition to an owner and the owner’s spouse. Entities that do not meet this requirement will not be issued a new business policy. There are no exceptions. |
|Sole Proprietor: When the owner is the only eligible and enrolled individual (or the owner and his/her spouse), it is not a group health plan unless at least |
|one other eligible common law employee (W-2 or 1099 for this business type) is enrolled in the plan. |
|Partnerships/LLP/LP/PLLP: If only partners and/or partners and their spouses are covered, they are not a group health plan unless there is at least one other |
|common law employee (W-2 or 1099 for this business type) eligible and enrolled in coverage. |
|Corporations and LLC/PLLC: Two owners who are not spouses may qualify as a group health plan. An additional common law employee is not required to enroll as |
|an owner may be considered a “common law employee” if working full time at the company – i.e. the group may consist of multiple owners only with no full-time |
|employees, where at least 1 owner is actively working and enrolled. If the Corp/LLC/PLLC has only 1 owner and/or owner and spouse as eligible it is not a group|
|health plan. |
|Children of 1 owner only or owner/spouse only business may be the other common law employee, if s/he is an eligible employee over the age of 18 (i.e., no |
|longer a minor child per state law) and is enrolled for coverage. |
|“Common Law Employee” determining factors: *Employee enrolling in coverage must still be full time eligible |
|The tax treatment of the worker (i.e., W-2 taxed or 1099) |
|A group may have an eligible 1099 employee as the enrolled common law employee, with the signed employer 1099 attestation form |
|The employer’s right to control the manner and means by which the work is completed; |
|Whether the employer provides the materials and tools necessary for the work; |
|Whether the employer has the right to assign additional projects to the worker; |
|The extent of the employer’s control over the worker’s hours; |
|Whether the work is part of the regular business of the employer |
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|Risk Mitigation Requirements |
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|Eligible Count |
|Tax Document Requirements |
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|1 - 9 |
|Determine necessary tax documents based on company type and length of time in business. |
|Documents will be fully reconciled except for ancillary-only submissions. |
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|10+ |
|For medical and ancillary-only submissions, the group must submit one of the following: |
|Quarterly wage and tax statement |
|Participation Certification Form |
|Applicable documents, if in business less than one year. |
|Note: Refer to the Type of Company and Length of Time in Business section. |
|For owner-only groups, at least one applicable ownership document based on length of time in business |
|Tax documents will not be reconciled except for the following: |
|Verification of company name/tax ID |
|Current dates (i.e., current pay periods/quarter) |
|Location of one member who is enrolling |
|Notes: |
|Tax documents are not required for groups that are 51+ based on their rating methodology. The only exceptions are groups that are considered small groups 1 – |
|100 PACE states. |
|The Participation Certification Form must be completely filled out (legal name, street address, effective date), signed, and dated. Do not install the eligible|
|count from this form. Also, ensure the correct section based on the state’s participation guidelines has been completed (floor calculation vs. participation |
|calculation). |
|The eligible count on the Participation Certification Form must be within 10% of the true eligible count being installed. |
|If tax documents are not provided at the time of submission to case installation, pend the group (do not withdraw) for this information. |
|Refer to the Reconciling a Payroll Document and Wage and Tax Statement sections for definitions of current payroll/quarterly statements. |
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|Tax Documentation Background |
|Tax documentation is used to ensure the same benefits are offered to all eligible employees in a group. This eliminates discrimination against employees in the|
|company who may have health conditions that could cause the group’s rates to be inflated. |
|Employees must be listed on the group’s wage and tax statement and earn full-time pay through the most recent quarter. |
|Tax documents are required to validate that individuals seeking coverage are actual, eligible employees, and that the employer/employee relationship exists. |
|A full-time employee is one who actively works on a full-time basis (per state guidelines), is earning at least minimum wage per the Fair Labor Standards Act, |
|and is referred to as a common law employee under HealthCare Reform (HCR) guidelines. |
|The following are not eligible for coverage: |
|Part-time and seasonal employees (except seasonal employees employed nine continuous months of the year and working the minimum number of required hours) |
|Individuals who volunteer time on behalf of the company (These individuals are not considered employees; therefore, they should not be offered coverage.) |
|Note: Not all shareholders, members of a board of directors, or previous owners are eligible for coverage unless they are actively employed on a full-time |
|basis and are able to support employment via applicable tax documentation. |
|The employer may use different tax documents depending on the type of business and the coverage requested. |
|Tax documentation is required for all employees and eligible owners and must be included with the final submission paperwork sent for installation. |
|Note: The group policy number will not be issued for non-SAM submissions until the appropriate wage and tax statement or payroll documentation is received |
|(showing all active employees). |
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|Tax Documentation Background, continued |
|If a group is sent to Installation without all required tax documentation or written exception approval: |
|The group will be pended, and a request will be made to the Sales Operations specialist (SOS) requesting the correct documentation or exception approval. |
|If an exception was not obtained, or case installation cannot approve the exception, the SOS will complete the Underwriting Exception Request Form, and send |
|the form to Risk Management for review and determination. |
|The installation process will continue after the tax documentation or the exception is allowed. |
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|Note: UnitedHealthcare reserves the right to request proof of ownership, additional payroll, or supporting tax documentation for any submissions. |
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|Proof of Ownership |
|Note: |
|Proof of ownership is defined as having proof that an owner owns a company. To be eligible, owners must work the required hours per week. |
|Salary amounts on ownership tax filings can be covered up or blackened out. |
|If the owners or partners appear on the wage and tax statement with the other employees, additional documentation is not required. |
|If the owners or partners do not appear on the wage and tax statement, additional tax forms are required to prove the owners or partners work for the company |
|as full-time employees. |
|If K-1 Forms are submitted, they do not need to account for 100% ownership. K-1 forms are only needed for owners who are eligible. |
|If K-1 Forms are submitted for an owner who did not submit an application/waiver, verification of the owner’s eligibility will be needed. |
|If a K-1 Form lists a company name instead of an owner name, and the owner of the company is considered eligible (waiving or applying for coverage), a K-1 Form|
|for the owner (linking him or her to the company) is also required. |
|If the K-1 Form lists ownership as a trust, no trust documentation is needed; however, verification on which employees are eligible under the trust will be |
|needed. |
|If the ownership paperwork submitted has multiple spaces for owners to sign, all owner signatures are required. If only one space for a signature exists, only |
|one signature is required (even if there are multiple owners listed on the document). |
|Electronically filed ownership paperwork will show the signature as a typed name; this is acceptable. |
|A printout from the IRS website confirming the group’s TIN is acceptable in place of the actual IRS/Secretary of State letter requirement. |
|When a group in business for longer than a year has a new eligible owner, request the most recently filed ownership documents, along with a signed document on |
|CPA letterhead indicating the ownership percentages and names. |
|When Articles of Incorporation/LLC Agreements are required, verification of the following is necessary: |
|Name of company |
|Date when the company was organized or when founding documents were filed with state (to verify when company started since IRS filings would not be available) |
|Owner/members indicated by name (Sometimes spelled out within the articles, but typically sign the document at the end as an owner.) |
|Note: An organizer, registered agent or manager do not confirm ownership. |
|If foreign tax documents are provided, but the company has not filed taxes in the United States (U.S.) yet, we may accept the foreign legal documentation along|
|with the IRS TIN letter. |
|Note: Only employees legally residing in the U.S. are eligible for enrollment |
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|Proof of Ownership, continued |
|When filing a tax extension, owners have until September 15 of the current year to file last year’s taxes (e.g., owners have until September 15, 2015, to file |
|a 2014 K-1 Form): |
|IMPORTANT: Refer to the following normal tax return due date examples. The most current tax filing must be provided. If after the normal due date, the |
|previous year’s filing and a copy of the Tax Extension Form (IRS Form 7004 or IRS Form 4868) will be required: |
|If the business is a corporation (C-Corp: Form 1120, S-Corp: Form 1120S), the income tax return or extension is due by the 15th day of the 3rd month after the |
|end of the tax year. |
|Example: Calendar year of company ends 12/31. The tax filing is due March 15. |
|If a group submitted a filed extension form, the prior year’s tax documentation would be needed in addition to the extension form. If the group was not in |
|business the previous year, the standard less than 1 year in business document(s) should be submitted in addition to the extension form. |
|Example: LLC submitted with a 5/1/17 effective date. They have been in business for 13 months, but have not filed their 2017 taxes. They need to provide their |
|original LLC agreement and Secretary of State/EIN form along with the extension document. |
|If the business is a partnership/LLC (Form 1065) or sole proprietor (Schedule C), the income tax return or extension is due by the 15th day of the 4th month |
|after the end of your tax year. |
|Example: Calendar year of company ends 12/31. The tax filing is due April 15. |
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|Type of Company and Length of Time in Business |
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|Adhere to these guidelines for the following company types: |
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|C-Corporation: |
|A C-Corporation is a corporation for which company profits are taxed separately from the owner’s profits under subchapter C of the Internal Revenue Code. |
|If a C-Corporation has been in business less than one year, articles of incorporation, an IRS or Secretary of State letter indicating issued tax ID number, and|
|a two-week payroll/quarterly wage and tax statement (if filed) for employees are required. |
|If a C-Corporation has been in business one year or more: |
|A wage and tax statement or quarterly payroll (if prepared by a payroll company) is required. |
|Pages 1 and 2 of the 1120 Form are required for owners who are not listed on the wage and tax statement. The Schedule G or the 1125E Form (listing all owners) |
|must also be provided. |
|If the 1120 Form does not list all the owners, a letter from the owners’ lawyer or certified public accountant (CPA) identifying all of the owners and their |
|percentage of ownership is acceptable. |
|Two owners who are not spouses will qualify as a group health plan. A W-2 or 1099 employee is not required to enroll as an owner may be considered a Common |
|Law Employee if working full time at the company, i.e. the group may consist of owners only with no full-time employees, where at least 1 owner is actively |
|working and enrolled. |
|Any corporation in which only the owner/partner and his or her spouse are eligible would not qualify for a small employer plan. Refer to the information |
|regarding spouse-only groups in the Other Company Types section. |
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|S-Corporation: |
|An S-Corporation is a corporation in which profits are passed on to shareholders and taxed on their personal returns under Subchapter S of the Internal Revenue|
|Code. |
|If the S-Corporation has been in business less than one year, articles of incorporation, an IRS or Secretary of State letter indicating issued tax ID number, |
|and a two-week payroll/quarterly wage and tax statement (if filed) for employees are required. |
|If the S-Corporation has been in business one year or more: |
|A wage and tax statement or a quarterly payroll (if prepared by a payroll company) is required. |
|A Schedule K-1 (Form 1120S) is required for all owners/partners if one (or more of the owners) is not indicated on the wage and tax statement. |
|Exception: For New Jersey (NJ) only, the NJ K-1 Form is acceptable. |
|Two owners who are not spouses will qualify as a group health plan. A W-2 or 1099 employee is not required to enroll as an owner may be considered a Common |
|Law Employee if working full time at the company, i.e. the group may consist of owners only with no full-time employees, where at least 1 owner is actively |
|working and enrolled. |
|Any corporation in which only the owner/partner and his or her spouse are eligible would not qualify for a small employer plan. Refer to the information |
|regarding spouse-only groups in the Other Company Types section. |
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|Sole proprietorship: |
|A sole proprietorship is a business that is not a formed entity and legally has no separate existence from the owner (e.g., a person doing business in his or |
|her own name or a DBA for which there is only one owner). |
|If a sole proprietorship has been in business less than one year, a business license, an IRS or Secretary of State letter indicating issued tax ID number (if |
|available), and two-week payroll/quarterly wage and tax statement (if filed) for all employees not listed on the license are required. |
|If a sole proprietorship has been in business one year or more: |
|A wage and tax statement or quarterly payroll (if prepared by a payroll company) is required. |
|A Schedule C is required for eligible owners if not present on the wage and tax/payroll. |
|If the spouse of a sole proprietor is an employee and not listed on the wage and tax statement, a current W2, two-week payroll, or Schedule SE |
|(Self-Employment) is required. |
|A Schedule C is required if the sole proprietorship is in the business of renting personal property. |
|A Schedule E is required if the sole proprietorship is in the business of renting commercial property. |
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|Notes: |
|Verify the Schedule C is filed for the most current year, and lists the employer’s name and tax ID number. |
|Sole proprietors may use Social Security numbers in lieu of tax ID numbers. |
|Except in Massachusetts, a sole proprietorship must have at least one full-time employee/1099 other than the owner (not a spouse) who is eligible and enrolling|
|to participate in the group plan under the plan documents. Any sole proprietorship in which only the owner and his or her spouse are eligible would not qualify|
|for a small employer plan. Refer to the information regarding spouse-only groups in the Other Company Types section. |
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|Type of Company and Length of Time in Business, continued |
|Partnership: |
|A partnership is formed when two or more people intend to work together to carry on a business activity. No local or state filings are required to create this |
|type of partnership. |
|An LLP (Limited Liability Partnership) has the same requirements. |
|If a partnership has been in business less than one year, a Partnership Agreement listing all partners, an IRS or Secretary of State letter indicating issued |
|tax ID number (if available), and a two-week payroll/quarterly wage and tax statement (if filed) for employees are required. |
|If a partnership has been in business one year or more: |
|A wage and tax statement or quarterly payroll (if prepared by a payroll company) is required for employees other than the partners in the group. |
|Schedule K-1 (Form 1065) required for all partners if one or more of the owners are not indicated on the wage and tax statement. |
|A Partnership Agreement is acceptable if the Schedule K-1 has not been filed. A copy of the filing extension is required at the time of submission. |
|Note: Except in Massachusetts, a partnership must have at least one full-time employee/1099 (not a spouse) other than a partner(s) who is eligible and |
|enrolling to participate in the group plan under the plan documents. Any partnership in which only the partner and his or her spouse, or only partners are |
|eligible, would not qualify for a small employer plan. Refer to the information regarding spouse-only groups in the Other Company Types section. |
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|Limited Liability Company (LLC): |
|An LLC is a business structure that is a hybrid of a partnership and an S-Corporation. Owners are shielded from personal liability, and all profits and losses |
|pass directly to the owners without taxation of the entity itself. |
|If the LLC has been in business less than one year, an LLC Agreement (signed by all parties), an IRS or Secretary of State letter indicating issued tax ID |
|number, and a two-week payroll/quarterly wage and tax statement (if filed) for all employees (other than those bound by the LLC Agreement) are required. |
|If the LLC has been in business one year or more: |
|A wage and tax statement or quarterly payroll (if prepared by a payroll company) is required. |
|A Schedule K-1 or Schedule C is required for all owners/partners if one (or more) of the owners is not showing on the wage and tax statement. |
|Except in Massachusetts, two owners who are not spouses will qualify as a group health plan. A W-2 or 1099 employee is not required to enroll as an owner may |
|be considered a Common Law Employee if working full time at the company, i.e. the group may consist of owners only with no full-time employees, where at least |
|1 owner is actively working and enrolled. |
|Any LLC in which only the owner/partner and his or her spouse are eligible would not qualify for a small employer plan. Refer to the information regarding |
|spouse-only groups in the Other Company Types section. |
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|Churches |
|Churches must provide a 941 or 940 Form and a two-week payroll/quarterly payroll/quarterly wage and tax statement (if filed) for all employees of the church. |
|Notes: |
|Groups consisting of only one eligible employee are allowed. |
|Religious orders (priests, nuns, monks, etc.) under a vow of poverty must provide a group letterhead signed by the director listing all eligible employees, |
|their salaries and hours worked. |
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|Farms |
|A farm must file a Schedule F and a two-week payroll/quarterly payroll/quarterly wage and tax statement (if filed) for all employees. |
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|Notes: |
|Verify the Schedule F is filed for the most current year, and indicates the employer’s name and tax ID number. |
|If the owner’s name and TIN are not present on the Schedule F, verification is needed on who the farmer/owner is. |
|Except in Massachusetts, if a sole proprietorship, there must be at least one full-time employee/1099 other than the owner (not a spouse) who is eligible and |
|enrolling to participate in the group plan under the plan documents. Any sole proprietorship in which only the owner and his or her spouse are eligible would |
|not qualify for a small employer plan. Refer to the information regarding spouse-only groups in the Other Company Types section. |
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|Type of Company and Length of Time in Business, continued |
|Nonprofit |
|A 941 or 940 Form and a two-week payroll/quarterly payroll/quarterly wage and tax statement (if filed) are required. |
|Notes: |
|For directors, Form 990 may be provided showing prior year full-time earnings as proof of eligibility. |
|For newly formed nonprofits, a 941 or 940 Form may not be available. A two-week payroll/quarterly payroll/ quarterly wage and tax statement is acceptable. |
|A group with eligible employees consisting only of an employee and his or her spouse is allowed. |
|Groups consisting of only one eligible employee are allowed. |
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|Common Ownership/Affiliates |
|Common ownership occurs when an employer owns more than one company and wants to cover all companies under one new business submission, or wants to cover |
|employees of only one company under the policy. |
|Notes: |
|A Common Ownership Form must be completed and submitted with the file. |
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|Older versions of the Common Ownership Form, if submitted, will not delay the group installation. |
|The NBR must know which group name should appear on the ID card and which tax ID number should be installed. |
|Refer to the Underwriting for Small Business Series Module for Common Ownership and Affiliates (located on the one website) for additional information and |
|guidelines: |
|At the top of the screen in the Customer Segment field, select Small Business from the drop-down menu. |
|Select Underwriting in the Products & Services tab. |
|Click Fully Insured: SB from the menu. |
|Click the Affiliates/Common Ownership module. |
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|Commission Employees: |
|For UnitedHealth Group to cover commissioned employees, the employer must complete a Commissioned Employees Form (if the commissioned employees are not |
|indicated on a wage and tax statement or acceptable payroll) indicating names of commissioned employees. |
|A year-to-date payroll ledger showing earnings for the commissioned employee must be submitted, if available. |
|Refer to the UnitedHealthcare Commission Employees Form for further conditions of eligibility for commissioned employees. |
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|Type of Company and Length of Time in Business, continued |
|Independent Contractor (1099 Employee): |
|For UnitedHealth Group to cover a 1099 employee, the employer must complete a UnitedHealthcare 1099 Form or provide the IRS 1099-MISC Tax Form for each 1099 |
|employee (depending on length of employment with company). |
|Employers may elect to offer coverage to independent contractors (1099 employees) if the following conditions are met: |
|The business has at least one regular, taxed employee, or owner who is eligible for coverage. Tax documentation must be submitted for the owner/employee to |
|prove eligibility based on the type of company. |
|The regular, taxed employee or an owner who is eligible for coverage is not required to enroll. |
|Note: A nonprofit may consist of only 1099 employees. |
|If the 1099 contractor has been employed by the group during the previous tax year, the IRS 1099-MISC Tax Form will be required to verify eligibility. If the |
|IRS 1099-MISC Tax Form has not yet been issued to the 1099 employee due to the length of time as a 1099 employee, the UnitedHealthcare 1099 Form will be |
|required. |
|Note: If the IRS 1099-MISC Tax Form is issued to a business name instead of the 1099 employee, ownership documentation will be required to prove the 1099 |
|contractor owns that particular business. |
|The Independent Contractor Form must list all 1099 employees. |
|Note: Due to regulations in certain states (refer to the All State Cheat Sheet), UnitedHealth Group cannot restrict the total number of 1099 independent |
|contractors a small employer can enroll if the group is considered 1099-eligible. |
|Refer to the UnitedHealthcare Independent Contractor Attestation Form for further conditions of eligibility for 1099 employees. |
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|Other Company Types |
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|Spouse-Only Groups: |
|Except in Massachusetts, or a nonprofit in any state, no new small employer policy should be issued to an entity that has no eligible employees/1099s other |
|than the owner and the owner’s spouse. Currently, state laws control which relationships are considered marriages. |
|The child of the sole owner may be the other eligible employee as long as he or she is 18 or over (no longer a minor child) and is eligible and enrolled for |
|coverage under the terms of the employer-sponsored plan. |
|A non-spousal, eligible employee/1099 must enroll in coverage for the entity to qualify for purchase of a small employer policy. |
|Sufficient tax or payroll documentation must be provided for all eligible enrollees to indicate they are either owners or employees. |
|Notes: |
|This applies to groups with both medical and ancillary-only coverage. |
|This applies to any business entity type (C-Corporation, S-Corporation, sole proprietor, LLC, etc.). |
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|Companies Using Payroll Services Only: |
|In certain situations, the employer may use the payroll services of a professional employer organization (PEO) or payroll company. UnitedHealthcare will accept|
|documentation from the PEO or payroll service on behalf of the employer. |
|Validation can be made by requesting a wage and tax statement or payroll listing the employees that are specific to the employer (containing no employees from |
|any other company). |
|If the employer cannot provide the health plan with a specific wage and tax statement or payroll, assume the employees are employees of the PEO/leasing company|
|and not eligible for coverage. |
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|Municipality |
|A quarterly wage and tax statement is required for all employees. |
|Notes: |
|Elected officials may be exempt from unemployment tax, and would not appear on the wage and tax statement. |
|A quarterly payroll is acceptable to show full-time earnings for elected officials. |
|Elected officials must be working required hours. |
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|Embassy |
|A listing of all eligible employees on the embassy letterhead, including the employees’ salary and hours worked, signed by management, is required. |
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|Wage and Tax Statement |
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|Employers are required to file a quarterly wage and tax statement in each state where they have employees. |
|The wage and tax statement must list all employees in the company. |
|The group must submit the most recent wage and tax statement with the case. |
|Notes: |
|If the owners or partners are not listed on the wage and tax statement, a Schedule C, K-1 Form, or another acceptable tax document must be provided at the time|
|of submission. |
|New hires who are not listed on the wage and tax statement (or who are handwritten) require a two-week payroll. |
|Groups will be processed, but the policy number will not be issued until all required tax documents are received. The group will be returned to the pend |
|representative, and the document will be reconciled before the Install Summary is generated and sent (no exceptions). |
|The following lists the average wage and tax statement availability: |
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|Quarter |
|Statement Available |
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|First (January, February, and March) |
|May 1 |
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|Second (April, May, and June) |
|August 1 |
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|Third (July, August, and September) |
|November 1 |
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|Fourth (October, November, and December) |
|February 1 |
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|Reconciling a Wage and Tax Document |
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|Use the following guidelines when reconciling a wage and tax statement: |
|Verify that the company’s name appears on the wage and tax statement. |
|Note: If the wage and tax statement is filed electronically, the name of the group may not appear; only the tax ID number may be provided. The tax ID number |
|should match the Employer Application for acceptance. |
|Verify the date of the wage and tax statement to ensure the current quarter has been submitted. |
|Note: If the health plan receives the group paperwork in a particular quarter, the wage and tax statement from that quarter may be accepted even if it is past |
|the wage and tax filing date. |
|Example: The group completed the applications in July, but the health plan received them on Aug. 3. In this case, the second quarter wage and tax statement is |
|required (because it is available on Aug. 1). |
|Verify the number of pages submitted to ensure no wage and tax statement pages are missing. |
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|Handwritten wage and tax statements are acceptable if the state form is used. |
|Note the status for part-time, seasonal, or terminated employees. |
|If you notice that employee earnings are unreasonably low while reviewing the wage and tax statement, examine the employee’s documentation more closely to |
|validate full-time earnings at minimum wage or higher, and determine eligibility. |
|Example: If a part-time employee’s wages are more than or equal to a full-time employee, determine if the full-time employee: |
|Is a new hire |
|Is on a leave of absence |
|Was previously laid off and is returning to work |
|Is a seasonal employee |
|Experienced a change in status |
|Note: Document the findings in the case installation file. |
|Verify that all full-time employees have submitted an application or a waiver. |
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|Notes: |
|If the owners or partners are not listed on the wage and tax statement, a Schedule C, K-1 Form, or other acceptable tax document must be provided at the time |
|of submission. |
|Salary amounts cannot be covered up or blackened out on a quarterly wage and tax statement. A revised copy will be requested. |
|If group is unable to provide a state wage and tax statement, we will accept a quarterly payroll created by a third- party payroll provider in lieu of the |
|state wage and tax. |
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|Reconciling a Payroll Document |
|. |
|Use the following guidelines when reconciling a payroll document: |
|Verify that all eligible employees have submitted an application or a waiver. |
|Note the status for part-time, seasonal, or terminated employees. |
|Verify the payroll dates of the pay period to ensure the current information has been submitted. A year-to-date (YTD) or quarterly report is acceptable for |
|groups in business less than a year, but not long enough to have a quarterly payroll. |
|Note: A current payroll must be within 60 days of the group's effective date. |
|Verify the number of pages submitted to ensure no payroll pages are missing. |
|Verify the company’s name appears on the payroll. |
|Include a total balance of wages and withholdings for the group and all employees. |
|List all employees on the same document. |
|Third-Party Administrator (TPA) payrolls [from Automatic Data Processing (ADP), Paychex, etc.] are acceptable. |
|In-house payrolls may be generated from payroll software programs such as Quicken, QuickBooks, Peachtree, etc., for groups that have been in business less than|
|a year. Refer to the Type of Company and Length of Time in Business section for payroll requirements. |
|Payrolls generated from an in-house source may be accepted as a third-party payroll if submitted alongside proof that a payroll company is completing the |
|group’s payroll such as a signed letter from the group’s CPA or a coversheet if there is no indication of such on the document. |
|Salary amounts cannot be covered up or blackened out on a payroll. A revised copy will be requested. |
|If you notice that employee earnings are unreasonably low while reviewing the wage and tax statement, examine the employee’s documentation more closely to |
|validate full-time earnings at minimum wage or higher, and determine eligibility. |
|Example: If a part-time employee’s wages are more than or equal to a full-time employee, determine if the full-time employee: |
|Is a new hire |
|Is on a leave of absence |
|Was previously laid off and is returning to work |
|Is a seasonal employee |
|Has experienced a change in status |
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|Other Acceptable Tax Documentation |
| |
|Deferral Owner/Partner/Officer: Submit the Deferral Agreement, which must include the following information: |
|Company letterhead |
|Amount of payment earned during the deferral period |
|Accounts payable statement that provides the details of payment earned |
|Time period of deferral agreement including start and end date (must not exceed 12 months) |
| |
|Commissioned Employee: |
|If the commission has been paid, submit the payroll showing the payment. |
|If no commission has been paid, complete and submit the UnitedHealthcare Commission Form. |
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|Unacceptable Tax Documentation |
| |
|The following are unacceptable tax documents: |
|W-2 (exception for the spouse of a sole proprietor), W-3, W-4, and W-9 Forms |
|Separate payroll sheets or pay stubs for each employee |
|Word document payroll |
|Excel versions of tax documents. Documents must be submitted in PDF or personalized report formats. Case install cannot convert files for the groups in order |
|to circumvent this requirement. |
|Letter from employer or CPA (unless otherwise outlined in this document) |
|Application for Employer Identification Number (SS4 Form) |
|Individual income tax returns (1040 Form) |
|Stock holder minutes |
|Stock certificates |
|Documents stating the enrollee is on a board of directors |
|Note: Members of a board of directors are not considered eligible unless they are actively employed on a full-time basis, and are able to support employment |
|via applicable tax documentation. |
|Estimated or projected payroll |
|Handwritten payroll |
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